Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Int J Gynecol Cancer. 2021 Jan;31(1):66-72. doi: 10.1136/ijgc-2020-001812. Epub 2020 Oct 12.
Fifteen per cent of women with cervical cancer are diagnosed with advanced disease and carry a 5 year survival rate of only 17%. Cervical cancer may lead to particularly severe symptoms that interfere with quality of life, yet few studies have examined the rate of palliative care referral in this population. This study aims to examine the impact of palliative care referral on women who have died from cervical cancer in two tertiary care centers.
We conducted a retrospective review of cervical cancer decedents at two tertiary institutions from January 2000 to February 2017. We examined how aggressive measures of care at the end of life, metrics defined by the National Quality Forum, interacted with clinical variables to understand if end-of-life care was affected. Univariate and multivariate parametric and non-parametric testing was used, and linear regression models were generated to determine unadjusted and adjusted associations between aggressive measures of care at the end of life with receipt of palliative care as the main exposure.
Of 153 cervical cancer decedents, 73 (47%) received a palliative care referral and the majority (57%) of referrals occurred during an inpatient admission. The median time from palliative care consultation to death was 2.3 months and 34% were referred to palliative care in the last 30 days of life. Palliative care referral was associated with fewer emergency department visits (OR 0.18, 95% CI 0.05 to 0.56), inpatient stays (OR 0.21, 95% CI 0.07 to 0.61), and intensive care unit admissions (OR 0.24, 95% CI 0.06 to 0.93) in the last 30 days of life. Palliative care did not affect chemotherapy or radiation administration within 14 days of death (p=0.36). Women evaluated by palliative care providers were less likely to die in the acute care setting (OR 0.19, 95% CI 0.07 to 0.51).
In two tertiary care centers, less than half of cervical cancer decedents received palliative care consultations, and those referred to palliative care were often evaluated late in their disease course. Palliative care utilization was also associated with a lower incidence of poor-quality end-of-life care.
15%的宫颈癌女性被诊断为晚期疾病，其 5 年生存率仅为 17%。宫颈癌可能导致严重的症状，严重影响生活质量，但很少有研究调查这一人群的姑息治疗转诊率。本研究旨在调查在两家三级保健中心死于宫颈癌的女性接受姑息治疗转诊的情况。
我们对 2000 年 1 月至 2017 年 2 月在两家三级机构死亡的宫颈癌患者进行了回顾性研究。我们研究了生命末期的积极治疗措施，以及国家质量论坛定义的指标如何与临床变量相互作用，以了解生命末期的护理是否受到影响。采用单变量和多变量参数和非参数检验，并生成线性回归模型，以确定生命末期积极治疗措施与姑息治疗作为主要暴露之间的未调整和调整关联。
在 153 名宫颈癌死者中，73 名（47%）接受了姑息治疗转诊，大多数（57%）转诊发生在住院期间。从姑息治疗咨询到死亡的中位时间为 2.3 个月，34%的人在生命的最后 30 天被转诊至姑息治疗。姑息治疗转诊与急诊就诊次数减少相关（OR 0.18，95%CI 0.05 至 0.56）、住院次数（OR 0.21，95%CI 0.07 至 0.61）和生命最后 30 天的 ICU 入院次数（OR 0.24，95%CI 0.06 至 0.93）。姑息治疗并不影响死亡前 14 天的化疗或放疗（p=0.36）。接受姑息治疗提供者评估的女性死于急性护理环境的可能性较小（OR 0.19，95%CI 0.07 至 0.51）。
在两家三级保健中心，不到一半的宫颈癌死者接受了姑息治疗咨询，而被转诊至姑息治疗的患者往往在疾病晚期才得到评估。姑息治疗的使用也与较低的低质量临终护理发生率相关。
